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With increased demands on physicians' time, increased complexity of medication management, and increased performance expectations, primary care physicians need not go it alone. Collaborating with clinical pharmacists is a promising way to expand team-based care.
Before you begin, establish a collaborative practice agreement that outlines the inclusion and exclusion criteria for clinical pharmacists' interventions, the classes of drugs clinical pharmacists may prescribe, and the degree of oversight from participating physicians.
You'll want to start small, but as your confidence in the team approach grows, you can extend your collaborations into more complex areas. Here are five tasks you can consider delegating:
1. Medication safety reviews for at-risk patients. You could refer patients to clinical pharmacists on an ad hoc basis or direct them to consult with all patients who meet specific criteria, such as those who use more than 10 prescriptions or those who use a dangerous medication.
2. Medication introductions and patient outreach. Some drugs produce early side effects or late benefits that may cause patients to stop using them. Clinical pharmacists can check in on these patients and reinforce the overall treatment goals.
3. Drug monitoring. Some drugs require frequent monitoring to avoid harm to patients. Examples include amiodarone (requires regular thyroid assessments), oral anti-fungal drugs and naltrexone (require monthly hepatic evaluations), testosterone, lithium, and anti-seizure medications.
4. Deprescribing. Clinical pharmacists can be highly effective at deprescribing unhelpful or hazardous medications. Drugs such as furosemide for edema, proton-pump inhibitors for gastroesophageal reflux, and selective serotonin reuptake inhibitors (SSRIs) for depression are eligible for trials of tapering and discontinuation. Aspirin, statins, and donepezil may also be reasonable candidates for deprescribing.
5. Population health. Clinical pharmacists can also partner with you to improve quality of care by using clinical registries to focus on key measures and high-risk patient populations.
Read the full article in FPM: “How to Integrate Clinical Pharmacists Into Primary Care.”
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